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Marijuana smoking and the risk of lung cancer: time for pause

While smoking marijuana may have recently been legalized, one shouldn’t conclude that it is necessarily healthy.

For individuals who treat lung cancer patients in the states of Washington and Colorado, the recently passed legislations raise serious concerns. Ironically, this happened on the eve of the 50th anniversary of the first US Surgeon General Report by Dr. Luther Terry in January 1964, which concluded that lung cancer is causally related to cigarette smoking. This report had followed decades of warnings by so-called common sense alarmists who had identified this as a major public health issue but who lacked the data to fully support their claims.

It is estimated that, in the US, we saw just over 225,000 new cases of lung cancer in 2012, 80 to 90% of these occurring in active or former cigarette smokers. That year, close to 160,000 American men and women died of their lung cancer. In the state of Washington alone, about 4,200 new cases were diagnosed. These numbers are quite disheartening considering the links that were clearly established and disseminated in the 1964 report and subsequently validated by a multitude of others since. This clearly shows that legal does not guarantee healthy.

Additionally, there is a 20-year lag in between the time when a population starts smoking and the time when the incidence of lung cancer begins to increase. In reverse, it takes 20 years before a decrease in consumption of cigarettes leads to a drop in the incidence of lung cancer.

Having recognized that clear link between tobacco and lung cancer, we are often asked if such a relationship exists with marijuana use as well.

The present medical literature on this issue is about as clear as were the medical and epidemiological literatures addressing lung cancer risks in cigarette smokers during the 1950s. Some population based (epidemiological) studies have concluded that smoking cannabis increases the risks, while others have suggested it doesn’t.

These studies, however, are limited by the fact that many marijuana smokers are also cigarette smokers, that some users mix tobacco and marijuana in their joint, and that the illegality of marijuana use may have influenced the willingness of participants to give honest answers regarding their use of marijuana, affecting the validity of the data used in these studies.

However, there are some facts that we should acknowledge. Laboratory work has demonstrated the occurrence of tissue, cellular and molecular pre-cancerous changes in the airways and lungs of cannabis users that are strikingly similar to those seen in cigarette smokers. Similarly, the carcinogenic effects of cannabis smoke have been demonstrated in both human and animal models: marijuana smoke contains 50 to 70% more carcinogenic hydrocarbons than tobacco smoke. Additional factors that may contribute to the carcinogenic potential of marijuana smoke are the tendency for marijuana to burn at a higher temperature and that marijuana smoke is typically inhaled deeper and held longer than tobacco smoke (two factors that promote prolonged contact duration of potential carcinogens on the lung lining).

Some argue that one or two joints per day of exposure to these carcinogens does not even come close to the 1 -2 packs per day contact a cigarette smoker experiences. While this may mathematically make sense, the fact is that we do not know of a safe level for such exposures. Some have estimated that one-joint-a-day is equivalent to a one-pack-a-day use of cigarettes. A 2008 study from New Zealand estimated that each joint-year* of cannabis exposure increases the risk of lung cancer by 8% after adjusting for confounding variables including tobacco smoking. Lastly, there are also some hints that these cancers may occur at a younger age.

In the same way that making it legal does not make it safe, a lack of data does not mean that there are no serious long-term consequences of smoking marijuana purely for recreational purposes. As a member of the medical community, my fear is that if legalization of marijuana leads to more recreational use by our children and adolescents, we may see an increase in the incidence of lung cancer in the 40 and 50 year old population… 20 years from now.

(*3 joint-years is either 1 joint a day for 3 years or 3 joints per day for 1 year)

I am no doctor just a logical thinker but do these studies incorporate Air pollution? I would think there would more cancer patiants in big cities due to air pollution. In NY/NJ the sky has a grey tint to it. I would think breathing that air could play a roll in lung cancer. Has anyone thought about this, We cut down more and more trees (earths natural air scubber) causing higher pollution levels that we breath in. As humans multiply more vehicales are on the road causing more pollution. Now there has been a rise of cancer. food for your thought.

I'm sorry doctor, but you are taking information related to studies on smoking cigarettes from the early 60's and tying that into marijuana, yet scoffing at Sharon's data because it's from the early 90's.

Tashkin's studies were actually published in 2006.

How about we bring more recent data into the conversation? How about data from this year? Specifically, the AACR from April of 2013.

"Our pooled results showed no significant association between the intensity, duration, or cumulative consumption of cannabis smoke and the risk of lung cancer overall or in never smokers. Cannabis use is under international control and its legal status varies, so reporting bias is of concern. However, since the reported prevalence in our data is comparable to nation-specific survey results and not differential between cases and controls, it is unlikely to fully explain the lack of significant association. Our results cannot preclude the possibility that cannabis may exhibit an association with lung cancer risk at extremely high dosage. We will also present data after applying restricted cubic splines to explore non-linear relationships."

Let's all be real here, isn't smoking anything bad for your lungs? Isn't that the real issue. Let's stop making cannabis into the boogeyman, the 30's are long gone.

Tashkin’s study is one of many and from the early 1990s. For every study Dr Tashkin has published, one can find a study from a different group concluding differently. The most recent published epidemiological study was from New Zealand and reported by Aldington et al. in the European Respiratory Journal in 2008. (See below.) However, these are epidemiological studies with significant weaknesses, by nature. The real concern is that when one biopsies the airways of cannabis smokers one frequently finds cellular and molecular changes similar to those seen as in tobacco smokers who then develop cancer. Some of the components of cannabis may have been shown to have anti-tumoral effect in the lab but there is a strong possibility that by delivering these compounds by smoking a joint, the destructive and pro-inflammatory reactions it exposes the lining of the airways outweigh and surpass any protective potential THC may harbor. A word of advice, brownies are much safer for your lungs…

"The risk of lung cancer increased 8% (95% confidence interval (CI) 2–15) for each joint-yr of cannabis smoking, after adjustment for confounding variables including cigarette smoking, and 7% (95% CI 5–9) for each pack-yr of cigarette smoking, after adjustment for confounding variables including cannabis smoking. The highest tertile of cannabis use was associated with an increased risk of lung cancer (relative risk 5.7 (95% CI 1.5–21.6)), after adjustment for confounding variables including cigarette smoking.In conclusion, the results of the present study indicate that long-term cannabis use increases the risk of lung cancer in young adults.” Eur Respir J 2008; 31:280-286

Enough evidence exists to conduct human studies, and yet the government stymies real life research. Other than potential risk of lung cancer and the chance that some smokers may be habituated to it, it is the safest substance being used, and much less addictive than most prescription drugs. In fact “UCLA's Dr. Donald Tashkin studied heavy marijuana smokers to determine whether the use led to increased risk of lung cancer and chronic obstructive pulmonary disease, or COPD. He had hypothesized that there would be a definitive link between cancer and marijuana smoking, yet the results proved otherwise.

"What we found instead was no association and even a suggestion of some protective effect," says Tashkin, whose research was the largest case-control study ever conducted. The study was funded by the National Institutes of Health.

Tobacco smokers in the study had as much as a 21-fold increase in lung cancer risk. Cigarette smokers, too, developed COPD more often in the study, and researchers found that marijuana did not impair lung function. Tashkin, supported by other research, concluded that the active ingredient tetrahydrocannabinol, or THC, has an "anti- tumoral effect" in which "cells die earlier before they age enough to develop mutations that might lead to lung cancer." “

Now, imagine if people could grow their own cancer medicine, pain 'killer" and even super food. What an ecomonic boom this would be for families and health insurance companies.